Monday, April 9, 2012

The other day a nurse was explaining to a patient that it is somewhat barbaric to have pain in labor. She was laughing and explaining why pain relief measures are completely and totally safe for the baby, and there is no reason to suffer in labor.

I think that pain relief measures in labor can be a wonderful thing, I think they are very varied and does not always mean that pain in labor is barbaric and not useful.

I think we have to remember that pain is different for each individual. Some people struggle with small amounts of pain, while others can handle high levels of pain.
We can see in labor at times, pain, while coping with it can help us as we work towards a goal, delivering a baby. Out of control pain, screaming, without focus can cause trauma, complications, and exhaustion.

Different pain relief measures have different side effects related to them, and in your choosing, you should be educating yourself on these for your particular situation. They do not all happen to everyone, but they are not as rare as you would think.

Some common methods of pain relief offered in a hospital setting, would be an Epidural, occasionally you would be offered a narcotic to take the edge off, until you are dilated to a point where an epidural would not slow down labor. But, depending on your hospital's policies, they may offer it at any time in labor, which is something you would want to weigh carefully.

When you receive an epidural, you will first be usually given 1-2 liters of fluid through an I.V. as it often causes blood pressure to drop rapidly, and this helps with that. You will be asked to sit on the bed with your back curled out, or lay on the bed on your side. You are usually allowed to have one support person in the room with you, while they are wearing a mask. They will sterilize a place on your back before numbing it. A needle will be inserted into the epidural space around the spinal cord in the lower back. A small catheter will be inserted and the needle removed. The catheter will be taped to your shoulder or your back to prevent it from being pulled on. If you received a regular epidural, they will also be giving you a urine catheter as you will not be able to walk to the bathroom anymore. Some hospitals will offer though a walking epidural or Intrathecal instead, which can mean you can still walk around, and be without a urine catheter. Often physicians discourage this if they think the labor could be lengthy, headed for a c-section or other complications, because they wear off. They do have their benefits though as well.

Side effects to receiving this pain relief can be wide and varied....
Some common ones-
- Your blood pressure may drop suddenly.
- Severe headache from leakage of spinal fluid. Less than 1% of women experience this, but it can occur for even weeks after you give birth, in the patients it occurs in. They can treat this by giving a blood patch.
-Shivering, shaking, ringing in the ears, backache, soreness where the needle was inserted, nausea, vomiting, and difficulty urinating.
- It can possibly make pushing more difficult, and cause a greater chance of the need for additional interventions such as Pitocin, forceps, vacuum extraction, or c-section can all be needed to progress.
- A few hours after birth- your lower body may still be numb.
-In rare instances- there may be permanent nerve damage where the catheter was inserted.
-There are some studies that breastfed babies that are born with an epidural, may struggle with latching on after an epidural. There are other studies about some of these other risk factors.

Among other studies that possible link it to greater chance of c-sections...

However, with all studies, you have to read, educate yourself, and decide for yourself.

A few observations that I have noticed is that women who never suffer pain in labor, tend to have a greater risk for Postpartum depression, struggle with bonding with the baby, as well as an issue with breastfeeding long term. I am not sure of the studies that have been done on that, but this article has several links to studies on the topic. Natural childbirth V: Epidural side effects and risks
It seems to be somewhat biased though, so look at the links and learn.

However, I have seen there is a time for pain relief besides the natural methods in labor.
A couple of those instances I can think of...
- A mother who is exhausted and just cannot relax effectively because she is just too worn out. A walking epidural or epidural can be a good option as she can sleep, resting and giving herself strength to be able to push.

- Someone who is having an induced labor. An induced labor can at times be more painful than a natural labor, and the pain can be harder to control naturally.

- If the patient is highly strung, low pain tolerance or is living in a highly stressful life situation, sometimes any pain can be hard to deal with and a medical intervention can be very helpful.

I highly encourage a mom who is planning on receiving pain medication, to learn some coping methods of dealing with labor pain, just in case she ends up being able to receive an epidural or something else in time. I have met many mothers that were very traumatized by going through labor pains, when they expected to have none. Some simple coping methods and preparation could possibly help them to get through without the trauma.

I would recommend that any childbirth classes you take, that you still pay attention to any methods of coping with labor pain without drugs, just in case something goes wrong with your birth plan.

On the other hand, I highly recommend if you are planning a completely natural birth, you research common drugs used in pain relief during labor in your local hospital, just in case you find yourself in a position to need to vary from your birth plan and find yourself caught off guard.

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